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Naser AY, Alwafi H, Al-Daghastani T, Hemmo SI, Alrawashdeh HM, Jalal Z, Paudyal V, Alyamani N, Almaghrabi M, Shamieh A. Drugs utilization profile in England and Wales in the past 15 years: a secular trend analysis. BMC PRIMARY CARE 2022; 23:239. [PMID: 36114471 PMCID: PMC9482186 DOI: 10.1186/s12875-022-01853-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Medication use assessment has a critical role in promoting the effective and rational use of pharmaceutical medications. There are no studies that have explored the utilization of all medications in England and Wales in the past 15 years without restrictions in the age group being studied or class of medications. AIM To explore the medication utilization pattern of dispensed medications in England and Wales in the past 15 years. METHOD A secular trend analysis study using publically available dispensing data on the population level in England and Wales for the duration between 2004 and 2019. Medication dispensing data was extracted from the Prescription Cost Analysis database. RESULTS Medication prescriptions rate increased by 42.6% [from 1,345,095.75 (95% CI 1,345,004.25 - 1,345,187.26) in 2004 to 1,918,138.48 (95% CI 1,918,038.38 - 1,918,238.57) in 2019 per 100,000 persons, trend test, p < 0.001]. During the study period, the most common medication prescriptions were for the cardiovascular system, central nervous system, and endocrine system, which accounted for 30.2%, 18.8%, and 9.4%, respectively. The rate of medication prescriptions for skin, immunological products and vaccines, infections, and musculoskeletal and joint diseases decreased by 18.4%, 15.8%, 9.8%, and 5.7%, respectively. CONCLUSION The last two decades have witnessed a remarkable rise in the quantity of medications dispensed in community settings. Utilization of chronic disease medications has increased in the past 15 years, specifically, dispensed medications for the cardiovascular system, central nervous system, and endocrine system. It is necessary to conduct additional cohort studies to investigate the clinical outcomes and prescribing safety of these medications.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Tamara Al-Daghastani
- Department of Medical Allied Sciences, Al-Balqa Applied University, Al-Salt, Jordan
| | - Sara Ibrahim Hemmo
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | | | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Vibhu Paudyal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Nawras Alyamani
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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Atak BM, Aktas G, Duman TT, Kurtkulagi O, Bilgin S, Kahveci G, Demirkol ME. Inappropriate Medication Use In Older Adults According To Beers Criteria In A Tertiary Referral Hospital, In Bolu, Turkey. RUSSIAN OPEN MEDICAL JOURNAL 2021; 10. [DOI: 10.15275/rusomj.2021.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023] Open
Abstract
Aims — We aimed to study the medications used by older adults for any potentially inappropriate medications. Material and Methods — A hundred and four consecutive subjects over 65 years of age who visited our clinic were enrolled in the study. Possible inappropriate medications were defined according to Beers Criteria. Results — A total of 57 women and 49 men were enrolled in the study. Mean ages of the women and men were 78.6±6.1 years and 77.4±5.4 years, respectively (p=0.30). While 18 subjects (17%) had no increased risk due to inappropriate use of medications, 30 were on inappropriate medications that increased renal failure risk, 5 were on inappropriate medication that amplified neurological side effects, 12 were on inappropriate medications that augmented bleeding risk, 20 were on inappropriate medication that lack safety and efficacy data, and 30 were on inappropriate medication that amplified the risk of falls. The number of increased risks according to Beers Criteria was significantly and positively correlated with number of medications used (r=0.366, p<0.001) and the number of comorbidities (r=0.312, p=0.001). Conclusion — The number of increased risks due to inappropriate use of medicines in older adults is positively correlated with the number of medicines used and the number of accompanied diseases. Therefore we suggest that the medicines used by older people should be reviewed in all settings, and unnecessary drugs should be avoided to be prescribed.
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Affiliation(s)
| | - Gulali Aktas
- Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Tuba T. Duman
- Abant Izzet Baysal University Hospital, Bolu, Turkey
| | | | | | - Gizem Kahveci
- Abant Izzet Baysal University Hospital, Bolu, Turkey
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Tsamakis K, Gadelrab R, Wilson M, Bonnici-Mallia AM, Hussain L, Perera G, Rizos E, Das-Munshi J, Stewart R, Mueller C. Dementia in People from Ethnic Minority Backgrounds: Disability, Functioning, and Pharmacotherapy at the Time of Diagnosis. J Am Med Dir Assoc 2020; 22:446-452. [PMID: 32758391 DOI: 10.1016/j.jamda.2020.06.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Increasingly, older populations in the United Kingdom and other well-resourced settings are ethnically diverse. Despite a concern that the prevalence of dementia is expected to rise, very little is known about the association of ethnicity and dementia among aging older adults. The current study aimed to compare ethnic group differences in symptom profile, functioning and pharmacotherapy at dementia diagnosis. DESIGN Cross-sectional study of patient characteristics at the point of dementia diagnosis. SETTING AND PARTICIPANTS In total, 12,154 patients aged 65 years or older diagnosed with dementia in Southeast London between 2007 and 2015. METHODS Data were extracted from the Clinical Record Interactive Search system, which provides anonymized access to the electronic health records of a large mental healthcare provider in Southeast London. Patients from ethnic minority backgrounds were compared with white British individuals on mental and physical well-being, functional scales and medications prescribed at dementia diagnosis, as well as subtype of dementia documented anywhere in the record. RESULTS Compared with white British patients, Black African and Black Caribbean patients were more likely to present with psychotic symptoms and were less likely to have an antidepressant prescribed; white Irish patients had higher rates of substance/alcohol use and depressive symptoms were more prevalent in South Asian patients; all ethnic minority groups had higher odds of polypharmacy; and vascular dementia diagnoses were more common in Black and Irish ethnic minority groups. CONCLUSIONS AND IMPLICATIONS At dementia diagnosis, there are substantial differences in noncognitive mental health symptoms and pharmacotherapy across ethnic minority groups and compared with the white British majority population. Some of these differences might reflect access/treatment inequalities or implicit unconscious bias related to ethnicity, influencing both. They need to be taken into consideration to optimize pathways into care and personalize assessment and management.
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Affiliation(s)
- Konstantinos Tsamakis
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; Second Department of Psychiatry, University General Hospital ATTIKON, School of Medicine, Athens, Greece
| | - Romayne Gadelrab
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mimi Wilson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | | | - Labib Hussain
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Gayan Perera
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Emmanouil Rizos
- Second Department of Psychiatry, University General Hospital ATTIKON, School of Medicine, Athens, Greece
| | - Jayati Das-Munshi
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
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Brandão GR, Teixeira L, Araújo L, Paúl C, Ribeiro O. Self-medication in older European adults: Prevalence and predictive factors. Arch Gerontol Geriatr 2020; 91:104189. [PMID: 32717589 DOI: 10.1016/j.archger.2020.104189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Self-medication, despite some benefits, carries many risks, especially when practiced by older adults who are polymedicated. Information addressing the prevalence and associated factors of self-medication in older age in a European context is scarce and sometimes contradictory. This paper aims to estimate the prevalence of self-medication among older adults across Europe and to identify its predictive factors. DESIGN Cross-sectional study. SETTING Micro-data from the European Health Interview Survey (2006-2009) was used. PARTICIPANTS The sample comprised 31,672 community-dwelling individuals aged 65 and over living in private households in 14 European countries. MEASUREMENTS The analyses explored the use, over the last two weeks, of any medicines, supplements, or vitamins that were not prescribed by a doctor. RESULTS The mean self-medication prevalence was 26.3 %, being the highest in Poland (49.4 %) and the lowest in Spain (7.8 %). Greater odds of self-medication were found for women and for participants who were younger, divorced, or presented a higher educational degree. The presence of long-standing illness and physical pain or not using prescribed medication also significantly increased the possibility of self-medication. A wide variation in the odds of self-medication between countries was also observed (up to 8 times more for Poland, compared to Spain). CONCLUSION Self-medication is a prevalent problem among older Europeans, and even though some think it is risk-free, dangers tend to be greater with advancing age. This study will help identify the groups most likely to have this behavior so that we can focus on targeted educative and preventive initiatives.
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Affiliation(s)
- Gabriela Rangel Brandão
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Porto, Portugal; Universidade Federal de Ciências da Saúde de Porto Alegre. Porto Alegre, Brazil
| | - Laetitia Teixeira
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal.
| | - Lia Araújo
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal; Escola Superior de Educação, Instituto Politécnico de Viseu, Viseu, Portugal
| | - Constança Paúl
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal
| | - Oscar Ribeiro
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal; Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal
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Per BL, Taylor AW, Gill TK. Prescription medicines, over-the-counter medicines and complementary and alternative medicines use: a comparison between baby boomers and older South Australians. AIMS Public Health 2019; 6:380-395. [PMID: 31909061 PMCID: PMC6940579 DOI: 10.3934/publichealth.2019.4.380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
Objective This study examines the difference in medication use between baby boomers (born between 1946–1965) and older people (born before 1946) to determine the proportion of people combining over-the-counter (OTC) medicines and complementary and alternative medicines (CAM) use with prescription medicine use. Design A clustered, multistage, systematic, random, self-weighting area sample was obtained and a face-to-face interview was conducted to examine the difference in use in prescription medicines, OTC, and CAM and factors associated with the use between baby boomers and older people. Setting South Australia. Participants Respondents aged 15 years and over participated in surveys conducted in autumn (March to May) of 2004 (n = 3015) and 2008 (n = 3,034) in which all respondents were asked to list their current medications. This study focuses on those participants whose age was in the range defined by baby boomers and older people. Main outcome measures Proportion in each age group taking prescription medicine, OTC medicine, and CAM were determined. Multivariable logistic regression analyses were performed to investigate the relationships between medication use and demographic variables. Results The results showed that older people were not only the higher users of prescriptions medicines but also OTC medicines and CAM. Gender and education were associated with the use of CAM. Conclusions Due to the high use of CAM and OTC, it is important for the prescriber to take a full history of medication use before prescribing to reduce potential problems associated with drug interactions.
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Affiliation(s)
- Bee Leng Per
- SA Pharmacy, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Anne W Taylor
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Tiffany K Gill
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Paliwal Y, Gendron TL, Jones RM, Moczygemba L, Nadpara PA, Slattum PW. A qualitative study to understand over-the-counter medication use and decision-making among residents of senior-living communities. Res Social Adm Pharm 2018; 15:730-737. [PMID: 30253975 DOI: 10.1016/j.sapharm.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION OTC medications are generally considered safe and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers' perceptions, beliefs, and their decision-making about OTC medication use. This study uses a qualitative approach to explore the knowledge, beliefs, and practices associated with OTC medication use and decision-making in adults aged 65 years and older. METHODS A set of focus groups (N = 10) were conducted in a sample of independently living older adult residents of senior apartment buildings (N = 80) using purposeful sampling. All focus groups were recorded, transcribed verbatim, and analyzed qualitatively. RESULTS Most participants considered OTC medications safe and effective to use if following the drug label instructions appropriately. Brand name products were perceived as equally or more effective compared to generic products by participants. Two approaches to OTC treatment decision-making were observed: 1) a decision to treat their symptoms by themselves (self-recommended) or 2) a decision to ask and/or follow their physician's recommendation (physician-recommended). Each of these treatment approaches may lead to the other depending on the person's financial and healthcare resources, the severity of the symptoms, experiences with the medication, and relationship with the physician. Maximum and fast relief was mentioned as the most important attribute in the final OTC purchase decision, followed by the lower cost, and easy to swallow dosage forms. Aspirin and ibuprofen were the two most frequently reported OTC medications associated with adverse effects and inappropriate use. CONCLUSIONS Older adults, in general, feel positive about OTC medications and are satisfied with using them. Considering the self-reported malpractices and side effects associated with OTC medications, older adults should be encouraged to make safe and responsible decisions about self-medication.
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Affiliation(s)
- Yoshita Paliwal
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, 410 N 12th Street, P.O. Box 980533, Richmond, VA, 23298-0533, USA.
| | - Tracey L Gendron
- Department of Gerontology, School of Allied Health Professions, Virginia Commonwealth University, Richmond, Virginia, 730 East Broad Street, Box 980228, Richmond, VA, 23298-0228, USA.
| | - Resa M Jones
- Department Chair and Associate Professor, Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, 1301 Cecil B. Moore Ave, Ritter Annex Room 917, Philadelphia, PA, 19122, USA.
| | - Leticia Moczygemba
- Health Outcomes & Pharmacy Practice, University of Texas College of Pharmacy, Division of Health Outcomes and Pharmacy Practice, University of Texas, Austin, Texas, 2409 University Avenue, STOP A1930, Austin, TX, 78712-1117, USA.
| | - Pramit A Nadpara
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, 410 N 12th Street, P.O. Box 980533, Richmond, VA, 23298-0533, USA.
| | - Patricia W Slattum
- Geriatric Pharmacotherapy Program, Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, 410 N 12th Street, P.O. Box 980533, Richmond, VA, 23298-0533, USA.
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Moßhammer D, Haumann H, Mörike K, Joos S. Polypharmacy-an Upward Trend with Unpredictable Effects. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:627-633. [PMID: 27743469 DOI: 10.3238/arztebl.2016.0627] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 11/25/2015] [Accepted: 06/06/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Guideline-oriented treatments can lead to polypharmacy, i.e., the simultaneous long-term use of multiple drugs. Polypharmacy mainly affects elderly patients. The goal of this review is to survey the current scientific evidence about polypharmacy, focusing on clinical endpoints, and to point out implications for medical practice and research. METHODS This selective literature review is based on pertinent publications that were retrieved by a selective search in PubMed employing the terms "polypharmacy AND general practice." Selected references were considered as well. RESULTS In Germany, polypharmacy currently affects approximately 42% of persons over age 65, with an ongoing upward trend. 20-25% of these patients receive potentially inappropriate drugs. Approximately 86% of the daily doses of drugs taken by persons over age 65 are prescribed by general practitioners. There is inconsistent evidence on the question whether polypharmacy affects clinical endpoints such as mortality. It cannot be determined with certainty whether polypharmacy itself, or the underlying multimorbidity, is the reason for worse clinical outcomes. Lists, instruments, and guidelines such as PRISCUS (a list of potentially inappropriate drugs for elderly patients), FORTA (Fit fOR The Aged), MAI (the Medication Appropriateness Index), and the Hausärztliche Leitlinie Multimedikation (a German-language guideline on polypharmacy for general practitioners) can help physicians take care of patients who are taking multiple drugs. It has not yet been proven, however, that their use has any effect on clinical outcomes. CONCLUSION The decision whether to keep giving a drug or to discontinue it must always be made individually on the basis of current treatment goals; drug lists and a pertinent general practitioners' guideline can be useful aids in decision-making. Efforts to pay more attention to multimorbidity and polypharmacy in future studies and guidelines are deserving of support.
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Affiliation(s)
- Dirk Moßhammer
- Joint first authors, Institute for General Medicine and Inter professional Care, Tübingen University Hospital, Tübingen, Department of Clinical Pharmacology, Tübingen University Hospital, Tübingen
| | | | | | - Stefanie Joos
- Institute for General Medicine and Inter professional Care, Tübingen University Hospital, Tübingen
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McStea M, McGeechan K, Kamaruzzaman SB, Rajasuriar R, Tan MP. Defining metabolic syndrome and factors associated with metabolic syndrome in a poly-pharmaceutical population. Postgrad Med 2016; 128:797-804. [DOI: 10.1080/00325481.2016.1229103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Megan McStea
- The Malaysian Elders Longitudinal Research (MELoR), University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Kevin McGeechan
- Centre for Medical Psychology and Evidence-based Decision-making, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Shahrul Bahyah Kamaruzzaman
- The Malaysian Elders Longitudinal Research (MELoR), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- The Malaysian Elders Longitudinal Research (MELoR), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Upchurch GA, Menon MP, Levin KS, Catellier DJ, Conlisk EA. Prescription Assistance for Older Adults with Limited Incomes: Client and Program Characteristics. J Pharm Technol 2016. [DOI: 10.1177/875512250101700102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To describe the sociodemographic, medication-related, health services utilization and health characteristics of the community-dwelling senior citizens (≥65 y) with limited incomes who enrolled in Senior PHARM Assist, a community-based prescription assistance program. Patients: Senior citizens (n = 387) enrolled in the program between June 1994 and May 1996. All eligible participants were 65 years of age or older, had incomes below 140% of the federal poverty level, but were not enrolled in Medicaid. All the patients were living in Durham County and were taking prescription medications. Measurements: Self- or caregiver-reported. In addition to demographic characteristics, polypharmacy (taking ≥5 prescription medications in the last month), medication adherence (adherence to directions on the medication container), medication knowledge (client or caregiver stated appropriate purpose for taking the medication), adverse effects from medications, and activities of daily living and instrumental activities of daily living limitations were measured. Results: Eighty percent of the senior citizens lived below the federal poverty level, 82% were women, 53% were African-American, 53% lived alone, and the mean monthly income for a single person was $595 and for a couple was $939. They were taking, on average, 8.9 medications, were adherent with 71% of their medications, knew the purpose of 69% of their medications, and reported adverse effects from 10% of their prescription medications. Conclusions: This population of community-dwelling seniors takes, on average, a higher number of prescription medications than previously reported, posing a higher risk for the hazards associated with polypharmacy and uncoordinated prescribing, such as nonadherence, drug interactions, and adverse effects. There may be a greater need for future intervention programs to include a comprehensive educational component, such as a coordinated medication review, in addition to financial assistance.
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Affiliation(s)
- Gina A Upchurch
- GINA A UPCHURCH RPh MPH, Clinical Assistant Professor, Department of Pharmacotherapy, School of Pharmacy, University of North Carolina, Chapel Hill, NC; Adjunct Instructor, Department of Health Behavior and Health Education, School of Public Health, University of North Carolina; Executive Director, Senior PHARMAssist, Durham, NC
| | - Manoj P Menon
- MANOJ P MENON MPH, at time of writing, Research Associate, Department of Health Education, North Carolina Central University, Durham; now, Medical Student, School of Medicine, University of North Carolina
| | - Kimberly S Levin
- KIMBERLY S LEVIN MD MPH, at time of writing, Medical Student, School of Medicine, University of North Carolina; now, Resident, Department of Emergency Medicine, Stanford University, Palo Alto, CA
| | - Diane J Catellier
- DIANE J CATELLIER PhD, Research Assistant Professor, Department of Biostatistics, School of Public Health, University of North Carolina
| | - Elizabeth A Conlisk
- ELIZABETH A CONLISK PhD, Clinical Assistant Professor, Department of Epidemiology, School of Public Health, University of North Carolina; Epidemiologist, Division of Community Health, North Carolina Department of Health and Human Services, Raleigh
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Ruby CM, Hanlon JT, Fillenbaum GG, Pieper CF, Branch LG, Bump RC. Medication Use and Control of Urination Among Community-Dwelling Older Adults. J Aging Health 2016; 17:661-74. [PMID: 16177455 DOI: 10.1177/0898264305279875] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this study is to evaluate whether the use of medications with urological activity (UA) is associated with self-reported difficulty in control of urination. Methods: This is a cross-sectional study using data from the Duke Established Populations for Epidemiologic Studies of the Elderly. Results: Difficulty holding urine was reported by 49.5% of men and 54.0% of the women. Overall, 50.9% of men and 72.7% of the women took one or more medications with UA. Multivariable logistic regression for men revealed that neither use of any medication with UA (Adjusted [Adj.] Odds Ratio [OR] 1.12, 95% confidence interval [CI] 0.84-1.50) nor the number of medications with UA used was associated with urinary difficulties (Adj. OR 1.08, 95% CI 0.97-1.21). For women, there was a significant association (p < .05) between use of any medication with UA and reported urinary difficulty (Adj. OR = 1.31, 95% CI = 1.05-1.62). Discussion: Medications with UA may be related to difficulty in controlling urine among community-dwelling elderly women.
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Affiliation(s)
- Christine M Ruby
- Duke University Medical Center, Veterans Affairs Medical Center, University of North Carolina, USA
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11
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Prevalence of Self-Medication and Associated Factors in an Elderly Population: A Systematic Review. Drugs Aging 2014; 31:883-96. [DOI: 10.1007/s40266-014-0217-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lee DS, de Rekeneire N, Hanlon JT, Gill TM, Bauer DC, Meibohm B, Harris TB, Jeffery SM. Cognitive Impairment and Medication Complexity in Community-Living Older Adults: The Health, Aging and Body Composition Study. J Pharm Technol 2012; 28:156-162. [PMID: 24660166 DOI: 10.1177/875512251202800405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Medication complexity is a large determinant of adherence. Few studies have explored the relationship between cognitive impairment and medication complexity. OBJECTIVE To evaluate whether cognitive impairment is associated with medication complexity for prescription and over-the-counter (OTC) medications. METHODS In this cross-sectional analysis, we studied the association between cognitive impairment and the complexity of prescription and OTC drug regimens. Baseline participants were from the Health, Aging and Body Composition study, consisting of 3075 well-functioning 70- to 79-year-old black and white men and women. Cognitive impairment was defined by having a Modified Mini-Mental State Examination score <80. The complexity of prescription and OTC (including supplements/herbals) medications was assessed using a modified version of the Medication Regimen Complexity Index (mMRCI). The mMRCI score increases with complexity of dosage forms, number of medications, pill burden, and nondaily dosing. RESULTS The mean (SD) age was 74 (2.9) years (n = 3055; 52% female, 41% black). The median prescription mMRCI score was 6 (range 0-66). The median OTC mMRCI score was 4 (range 0-71). Adjusting for health status, demographics, and access to care, medication complexity was lower in participants with cognitive impairment for prescription (adjusted RR 0.89; 95% CI 0.80 to 0.99) and OTC medications (adjusted RR 0.76; 95% CI 0.64 to 0.93) compared to those without cognitive impairment. The number of prescription medications was not different, but the number of OTC drugs was lower for those with cognitive impairment. CONCLUSIONS In this cohort of well-functioning older adults, those with cognitive impairment had lower prescription complexity due to less-complex dosage forms, pill burden, or daily dosing. OTC complexity was also lower, primarily due to a lower number of OTC drugs. The results of this study show that further research on medication complexity and adherence and health outcomes in cognitively impaired individuals is warranted.
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Affiliation(s)
- David Sh Lee
- Section of Geriatrics, School of Medicine, Yale University, New Haven, CT; now, Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR
| | | | - Joseph T Hanlon
- Division of Geriatric Medicine and Geriatric Research Education, University of Pittsburgh, and Clinical Center/Center for Health Equity Research and Policy, Pittsburgh Veterans Affairs Health Care System, Pittsburgh, PA
| | - Thomas M Gill
- Section of Geriatrics, School of Medicine, Yale University
| | - Douglas C Bauer
- Division of General and Internal Medicine, University of California, San Francisco
| | - Bernd Meibohm
- Department of Pharmaceutical Sciences, University of Tennessee, Memphis, TN
| | - Tamara B Harris
- Geriatric Epidemiology Section, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD
| | - Sean M Jeffery
- School of Pharmacy, University of Connecticut, Storrs, CT
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Silva GDOB, Gondim APS, Monteiro MP, Frota MA, de Meneses ALL. Uso de medicamentos contínuos e fatores associados em idosos de Quixadá, Ceará. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2012; 15:386-95. [DOI: 10.1590/s1415-790x2012000200016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 11/09/2011] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar a polifarmácia (uso diário de dois ou mais) de medicamentos contínuos e seus fatores associados em idosos. MÉTODOS: Estudo seccional realizado com idosos residentes em área urbana do município de Quixadá-CE, no período de maio a dezembro de 2009. A amostra compôs-se de 384 indivíduos, com 60 anos ou mais, usuários de medicamentos contínuos. As variáveis estudadas foram as sociodemográficas, econômicas e das características de saúde e referentes ao uso de medicamentos. Para a análise da associação entre a variável dependente polifarmácia de medicamentos contínuos e as variáveis independentes foi elaborado um modelo de regressão logística. RESULTADOS: Os resultados mostram predominância de idosos do sexo feminino, faixa etária entre 60 e 69 anos, casados, ensino fundamental incompleto, sem exercer atividade remunerada, renda familiar de até um salário mínimo, habitando em moradia própria, residindo com até três pessoas. Constatou-se uma prevalência de 70,6% de polifarmácia em idosos, sendo mais elevada no sexo feminino (66,4%). Os fatores associados positivamente ao uso de dois ou mais medicamentos contínuos foram: renda familiar acima de um salário mínimo (OR 2,83; IC95% = 1,54-5,32); duas ou mais condições crônicas autorreferidas (OR 17,71; IC95% = 9,80-31,990) e autopercepção da qualidade de vida regular e ruim (OR 2,85; IC95% = 1,60-5,07). CONCLUSÕES: Constatou-se uma prática de polifarmácia de medicamentos contínuos em idosos com renda familiar superior a um salário mínimo, que apresenta duas ou mais condições crônicas e autopercepção da sua qualidade de vida entre regular e ruim. Situação que remete a questões relativas aos aspectos social, cultural, econômico e de saúde.
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Newman AB. An overview of the design, implementation, and analyses of longitudinal studies on aging. J Am Geriatr Soc 2010; 58 Suppl 2:S287-91. [PMID: 21029055 DOI: 10.1111/j.1532-5415.2010.02916.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Longitudinal studies have contributed substantially to understanding of aging and geriatric syndromes. These efforts have provided a base of knowledge of the critical factors to consider in designing and implementing new longitudinal studies in older adults. This review highlights some of the major considerations in planning and implementing this type of study. Longitudinal studies can assess change over time and specific disease endpoints. Such projects require multidisciplinary teams with expertise in the many health and contextual factors that must be considered. Recent advances in study design include the use of imaging and biomarkers to assess mechanisms and approaches that raise the ceiling on measurement and integrate assessment of exposures over time. Study implementation requires careful planning and monitoring to maintain fidelity to the scientific goals. Analysis of longitudinal data requires approaches that account for inevitable missing data. New studies should take advantage of the experience obtained from longitudinal studies on aging already conducted.
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Affiliation(s)
- Anne B Newman
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Polypharmacy in nursing home residents in the United States: Results of the 2004 National Nursing Home Survey. ACTA ACUST UNITED AC 2010; 8:63-72. [DOI: 10.1016/j.amjopharm.2010.01.001] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2009] [Indexed: 11/17/2022]
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Advanced practice registered nurse usability testing of a tailored computer-mediated health communication program. Comput Inform Nurs 2010; 28:32-41. [PMID: 19940619 DOI: 10.1097/ncn.0b013e3181c0484e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study tested the usability of a touch-screen-enabled Personal Education Program with advanced practice RNs. The Personal Education Program is designed to enhance medication adherence and reduce adverse self-medication behaviors in older adults with hypertension. An iterative research process was used, which involved the use of (1) pretrial focus groups to guide the design of system information architecture, (2) two different cycles of think-aloud trials to test the software interface, and (3) post-trial focus groups to gather feedback on the think-aloud studies. Results from this iterative usability-testing process were used to systematically modify and improve the three Personal Education Program prototype versions-the pilot, prototype 1, and prototype 2. Findings contrasting the two separate think-aloud trials showed that APRN users rated the Personal Education Program system usability, system information, and system-use satisfaction at a moderately high level between trials. In addition, errors using the interface were reduced by 76%, and the interface time was reduced by 18.5% between the two trials. The usability-testing processes used in this study ensured an interface design adapted to APRNs' needs and preferences to allow them to effectively use the computer-mediated health-communication technology in a clinical setting.
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Goh LY, Vitry AI, Semple SJ, Esterman A, Luszcz MA. Self-medication with over-the-counter drugs and complementary medications in South Australia's elderly population. Altern Ther Health Med 2009; 9:42. [PMID: 19906314 PMCID: PMC2778637 DOI: 10.1186/1472-6882-9-42] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 11/11/2009] [Indexed: 11/17/2022]
Abstract
Background A number of surveys have examined use of complementary and alternative medicines (CAM) in Australia. However, there are limited Australian data on use of CAM and over-the-counter (OTC) medicines in the elderly population. The main aims of this study were to examine self-medication practices with CAM and OTC medicines among older Australians and variables associated with their use. Methods The Australian Longitudinal Study of Ageing (ALSA) is an ongoing multidisciplinary prospective study of the older population which commenced in 1992 in South Australia. Data collected in 4 waves of ALSA between 1992 and 2004 were used in this study with a baseline sample of 2087 adults aged 65 years and over, living in the community or residential aged care. OTC medicines were classified according to the World Health Organization Anatomical Therapeutic Chemical (ATC) classification. CAM were classified according a modified version of the classification adopted by the Therapeutics Goods Administration (TGA) in Australia. Results The prevalence of CAM or OTC use ranged from 17.7% in 2000-2001 to 35.5% in 2003-2004. The top classes of CAM and OTC medicines used remained relatively constant over the study period. The most frequent classes of CAM used were vitamins and minerals, herbal medicines and nutritional supplements while the most commonly used OTC were analgesics, laxatives and low dose aspirin. Females and those of younger age were more likely to be CAM users but no variable was associated with OTC use. Conclusion Participants seemed to self-medicate in accordance with approved indications, suggesting they were informed consumers, actively looking after their own health. However, use of analgesics and aspirin are associated with an increased risk of adverse drug events in the elderly. Future work should examine how self-medication contributes to polypharmacy and increases the risk of adverse drug reactions.
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Veehof LJG, Jong BMD, Haaijer-Ruskamp F. Polypharmacy in the elderly -a literature review. Eur J Gen Pract 2009. [DOI: 10.3109/13814780009069956] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sleath B, Ballinger R, Covert D, Robin AL, Byrd JE, Tudor G. Self-reported prevalence and factors associated with nonadherence with glaucoma medications in veteran outpatients. ACTA ACUST UNITED AC 2009; 7:67-73. [PMID: 19447359 DOI: 10.1016/j.amjopharm.2009.04.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of the current study was to determine the self-reported prevalence of and factors associated with nonadherence with glaucoma medications in veteran outpatients. METHODS This survey study was conducted at a Veterans Affairs (VA) clinic. A survey was administered to patients with glaucoma. We calculated the percentage of self-reported adherence with glaucoma medications in each patient. Logistic regression was used to assess whether patient characteristics and difficulties with using glaucoma medications were related to patients' reporting that they were <100% adherent with their glaucoma medications in the previous week. RESULTS The survey was completed by 141 patients (men, 91.5%; mean [SD] age, 70.22 [11.60] years [range, 37-93 years]; black race, 45.4%; white race, 44.0%; "other" or data unavailable, 10.6%). Nonwhite patients were significantly less adherent in the previous week than were white patients (27.0% vs 11.3%; P < 0.05). A total of 67.4% patients reported > or =1 difficulty in using their glaucoma medications. The 3 most commonly reported difficulties were "drops fall on cheek" (29.1%), "too many drops come out" (20.6%), and "hard to read print" (17.0%). A total of 19.1% of patients self-reported using <100% of their glaucoma medications in the previous week. The number of difficulties reported was significantly associated with reporting being <100% adherent in the previous week (P<0.05). CONCLUSION In this small sample of VA patients with glaucoma, adherence to glaucoma medications could be improved, especially among those who reported difficulties using their medications and those who were nonwhite.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA.
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Gokce Kutsal Y, Barak A, Atalay A, Baydar T, Kucukoglu S, Tuncer T, Hizmetli S, Dursun N, Eyigor S, Saridogan M, Bodur H, Canturk F, Turhanoglu A, Arslan S, Basaran A. Polypharmacy in the elderly: a multicenter study. J Am Med Dir Assoc 2009; 10:486-90. [PMID: 19716065 DOI: 10.1016/j.jamda.2009.03.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 03/27/2009] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the polypharmacy issue and its correlations with socioeconomic variables in Turkish elderly patients. DESIGN Cross-sectional SETTING Outpatient clinics of the medical schools, departments of physical medicine and rehabilitation from 12 provinces. PARTICIPANTS A total of 1430 elderly in different geographical regions of Turkey during January 2007 to January 2008 were included. MEASUREMENTS Patients were interviewed using a questionnaire that included demographic characteristics, current medical diagnosis, and pharmaceuticals that are used by elderly. Demographical parameters were gender, age, marital status, number of children, level of education, province, and status of retirement. RESULTS The mean number of drugs was found to be higher in the females. There was a significant difference among age groups, marital status groups, and the number of children categories. The distribution of the number of drugs among education levels did not differ significantly, whereas the distribution of the number of drugs between the status of retirement and presence of chronic disease differed significantly. CONCLUSIONS Polypharmacy is correlated with various factors including age, sex, marital status, number of children, status of retirement, and presence of chronic medical conditions but not educational status in our study group.
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Affiliation(s)
- Yesim Gokce Kutsal
- Hacettepe University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkey.
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Wright RM, Roumani YF, Boudreau R, Newman AB, Ruby CM, Studenski SA, Shorr RI, Bauer DC, Simonsick EM, Hilmer SN, Hanlon JT. Effect of central nervous system medication use on decline in cognition in community-dwelling older adults: findings from the Health, Aging And Body Composition Study. J Am Geriatr Soc 2009; 57:243-50. [PMID: 19207141 DOI: 10.1111/j.1532-5415.2008.02127.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate whether combined use of multiple central nervous system (CNS) medications over time is associated with cognitive change. DESIGN Longitudinal cohort study. SETTING Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS Two thousand seven hundred thirty-seven healthy adults (aged > or =65) enrolled in the Health, Aging and Body Composition study without baseline cognitive impairment (modified Mini-Mental State Examination (3MS) score > or =80). MEASUREMENTS CNS medication (benzodiazepine- and opioid-receptor agonists, antipsychotics, antidepressants) use, duration, and dose were determined at baseline (Year 1) and Years 3 and 5. Cognitive function was measured using the 3MS at baseline and Years 3 and 5. The outcome variables were incident cognitive impairment (3MS score <80) and cognitive decline (> or =5-point decline on 3MS). Multivariable interval-censored survival analyses were conducted. RESULTS By Year 5, 7.7% of subjects had incident cognitive impairment; 25.2% demonstrated cognitive decline. CNS medication use increased from 13.9% at baseline to 15.3% and 17.1% at Years 3 and 5, respectively. It was not associated with incident cognitive impairment (adjusted hazard ratio (adj HR)=1.11, 95% confidence interval (CI)=0.73-1.69) but was associated with cognitive decline (adj HR 1.37, 95% CI=1.11-1.70). Longer duration (adj HR=1.39, CI=1.08-1.79) and higher doses (>3 standardized daily doses) (adj HR=1.87, 95% CI=1.25-2.79) of CNS medications suggested greater risk of cognitive decline than with nonuse. CONCLUSION Combined use of CNS medications, especially at higher doses, appears to be associated with cognitive decline in older adults. Future studies must explore the effect of combined CNS medication use on vulnerable older adults.
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Affiliation(s)
- Rollin M Wright
- Department of Medicine, University of Pittsburgh, Pennsylvania 15213, USA.
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Wang J, Mullins CD, Zuckerman IH, Walker GD, Suda KJ, Yang Y, White-Means SI. Medical Expenditure Panel Survey: A valuable database for studying racial and ethnic disparities in prescription drug use. Res Social Adm Pharm 2008; 4:206-17. [DOI: 10.1016/j.sapharm.2007.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 06/20/2007] [Accepted: 06/22/2007] [Indexed: 10/21/2022]
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Lakey SL, Gray SL, Ciechanowski P, Schwartz S, Logerfo J. Antidepressant use in nonmajor depression: secondary analysis of a program to encourage active, rewarding lives for seniors (PEARLS), a randomized controlled trial in older adults from 2000 to 2003. ACTA ACUST UNITED AC 2008; 6:12-20. [PMID: 18396244 DOI: 10.1016/j.amjopharm.2008.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is estimated that major depressive disorder affects 0.9% of community-dwelling older adults in the United States. However, as many as 18% of older US adults reportedly suffer from depressive symptoms that do not necessarily fit the criteria for major depressive disorder (eg, dysthmia, minor depression). OBJECTIVES The goals of this study were to describe patterns of antidepressant medication use in older adults with dysthymia or minor depression and to examine factors associated with the use of antidepressants at baseline. METHODS This was a secondary analysis using cross-sectional data collected during a randomized controlled trial conducted from 2000 through 2003. It involved community senior service agencies and in-home visits in Seattle, Washington. Adults aged >or=60 years who had minor depression or dysthymia and were receiving services through community senior service agencies or living in senior public housing were included. Study participants were classified as users or nonusers of antidepressants. Prescription medication use in the past 2 weeks was assessed at baseline and 6 and 12 months. Medication name, dose, and directions were recorded from the medication label. Logistic regression was used to examine variables associated with baseline antidepressant use. RESULTS A total of 138 patients (mean age, 73.00 years) were included; the majority of study participants were female (779.00%). Overall, 42.33% were nonwhite (34.3% black, 4.4% Asian, 1.5% American Indian/Alaskan Native, 0.7% Hispanic, and 1.5% other). At baseline, 36.2% of study participants (n = 50) were using antidepressants. Selective serotonin reuptake inhibitors were the most common class of antidepressants, used by 62.00%, 70.22%, and 71.11% of antidepressant users at baseline, 6, and 12 months, respectively. However, nortriptyline was the most common antidepressant at baseline, taken by 20.00% of antidepressant users. Use of other prescription medications was associated with antidepressant use at baseline. CONCLUSIONS We found antidepressant use to be low in these relatively poor, community-dwelling, ethnically diverse older adults with dysthymia and minor depression in 2000 through 2003, with 36.22% of participants using antidepressants at baseline. Antidepressant users were more likely to be taking other prescription medications than nonusers.
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Affiliation(s)
- Susan L Lakey
- Department of Pharmacy, University of Washington, Box 357630, Seattle, WA 98195, USA.
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Allen KD, Renner JB, DeVellis B, Helmick CG, Jordan JM. Racial differences in sleep medication use: a cross-sectional study of the Johnston County Osteoarthritis Project. Ann Pharmacother 2008; 42:1239-46. [PMID: 18628443 DOI: 10.1345/aph.1l111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Little is known about racial differences in the use of sleep medications. OBJECTIVES To compare sleep medication use among African Americans and whites with self-reported current sleep problems. METHODS Participants were 1910 individuals (69% female, 34% African American, 66% white) from the Johnston County Osteoarthritis Project. We examined racial differences in self-reported current use of prescription, nonprescription, herbal, and other medications for sleep. Multivariable logistic regression models controlled for age, sex, education, health insurance, symptomatic hip or knee osteoarthritis, depressive symptoms, obesity, fair or poor general health, and self-reported annual days of sleep problems. Models were conducted separately for the whole sample and for men and women. RESULTS Among participants with current sleep problems, 31% were using one or more types of sleep medication: 17% prescription, 12% nonprescription, 1% herbal, and 3% other products. African Americans were less likely than whites to be using any sleep medication (25% vs 35%; p < 0.001), prescription sleep medication (14% vs 19%; p = 0.003), and nonprescription sleep medication (10% vs 13%; p = 0.048). These racial differences persisted in multivariable models. In sex-stratified analyses, there were significant racial differences in sleep medication use only among women. CONCLUSIONS African Americans were less likely than whites to report current use of prescription and nonprescription sleep medications; these results appeared to be largely driven by racial differences among women. Additional research should study possible underlying factors and determine whether these racial differences impact clinical outcomes.
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Affiliation(s)
- Kelli D Allen
- Department of Medicine, Health Services Research and Development Service, Durham Veterans Affairs Medical Center, Duke University Medical Center, Durham, NC 27705, USA.
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Jean-Louis G, Magai C, Casimir GJ, Zizi F, Moise F, McKenzie D, Graham Y. Insomnia symptoms in a multiethnic sample of American women. J Womens Health (Larchmt) 2008; 17:15-25. [PMID: 18240978 DOI: 10.1089/jwh.2006.0310] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ethnic disparities in socioeconomic factors, risk markers, and coping styles affect health status. This study examined whether those factors influence insomnia symptoms in a multiethnic sample of urban American women. METHODS Women (n = 1440, average age = 59.5 +/- 6.45 years) participating in the study were recruited using a stratified, cluster sampling technique. The sample comprises African Americans (22%), English-speaking Caribbeans (22%), Haitians (22%), Dominicans (12%), Eastern Europeans (11%), and European Americans (11%). Trained staff conducted face-to-face interviews lasting 1.5 hours acquiring demographic, health, and sleep data. RESULTS Analysis indicated significant ethnic differences in socioeconomics, risk markers, and health characteristics. The prevalence of insomnia symptoms (defined as either difficulty initiating sleep, difficulty maintaining sleep, or early morning awakening) among African Americans was 71%, English-speaking Caribbeans 34%, Haitians 33%, Dominicans 73%, Eastern Europeans 77%, and European Americans 70%. Hierarchical regression results showed that ethnicity explained 20% of the variance in the insomnia variable. Sociodemographic factors explained 5% of the variance, risk markers explained 5%, medical factors 20%, and coping styles 1%. Goodness-of-fit test indicated the model was reliable [chi-square = 276, p < 0.001], explaining 51% of the variance. CONCLUSIONS Findings show interethnic heterogeneity in insomnia symptoms, even among groups previously assumed to be homogeneous. Different factors seemingly influence rates of insomnia symptoms within each ethnic group examined. These findings have direct relevance in the management of sleep problems among women of different ethnic backgrounds. Understanding of ethnic/cultural factors affecting the sleep experience is important in interpreting subjective sleep data.
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Affiliation(s)
- Giardin Jean-Louis
- Department of Neurology and Ophthalmology, Brooklyn Center for Health Disparities, SUNY Downstate Medical Center, Brooklyn, New York 11203-2098, USA.
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Use of Conventional and Nonconventional Treatments for Osteoarthritis in the Family Medicine Setting. South Med J 2008; 101:252-9. [PMID: 18364653 DOI: 10.1097/01.smj.0000308363.10237.54] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. ACTA ACUST UNITED AC 2008; 5:345-51. [PMID: 18179993 DOI: 10.1016/j.amjopharm.2007.12.002] [Citation(s) in RCA: 741] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Polypharmacy (ie, the use of multiple medications and/or the administration of more medications than are clinically indicated, representing unnecessary drug use) is common among the elderly. OBJECTIVE The goal of this research was to provide a description of observational studies examining the epidemiology of polypharmacy and to review randomized controlled studies that have been published in the past 2 decades designed to reduce polypharmacy in older adults. METHODS Materials for this review were gathered from a search of the MEDLINE database (1986-June 2007) and International Pharmaceutical Abstracts (1986-June 2007) to identify articles in people aged >65 years. We used a combination of the following search terms: polypharmacy, multiple medications, polymedicine, elderly, geriatric, and aged. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that measured polypharmacy. RESULTS The literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality. There are few rigorously designed intervention studies that have been shown to reduce unnecessary polypharmacy in older adults. The literature review identified 5 articles, which are included here. All studies showed an improvement in polypharmacy. CONCLUSIONS Many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring.
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Affiliation(s)
- Emily R Hajjar
- Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania 15213, USA
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Wang J, Zuckerman IH, Miller NA, Shaya FT, Noel JM, Mullins CD. Utilizing new prescription drugs: disparities among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites. Health Serv Res 2007; 42:1499-519. [PMID: 17610435 PMCID: PMC1955281 DOI: 10.1111/j.1475-6773.2006.00682.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine racial and ethnic disparities in new prescription drug use. DATA SOURCES/STUDY SETTING Secondary data analyses of the Medical Expenditure Panel Survey (1996-2001), a national survey representative of U.S. noninstitutionalized civilian population. Drug approval dates were from the GenRx database of Mosby. STUDY DESIGN A negative binomial model was used to compare annual number of times when new drugs were obtained across racial and ethnic groups. Covariates in the model were demographic, economic characteristics, and health status. Drugs were considered new if approved within the past 5 years. We compared non-Hispanic whites with non-Hispanic blacks, and non-Hispanic whites with Hispanic whites, respectively, to examine racial and ethnic disparities separately. PRINCIPAL FINDINGS Descriptive analyses found smaller racial disparities than ethnic disparities: the average annual number of times when new drugs were obtained was higher among non-Hispanic whites than non-Hispanic blacks (1.71 versus 1.36; p<.01) and Hispanic whites (1.71 versus 1.11; p<.01). Multivariate analyses found smaller ethnic than racial disparities: the number was 22-33 percent lower among non-Hispanic blacks than non-Hispanic whites (significant), and 5-16 percent lower among Hispanic whites than non-Hispanic whites (not always significant), respectively. While the absolute racial disparities decreased over the early years of the life cycles of the products, the reduction in disparities over time was not significant. CONCLUSIONS There are racial disparities in the use of new medications, which persist during the first 5 years of marketing. Socioeconomic and health characteristics account for a larger share of ethnic disparities than racial disparities.
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Affiliation(s)
- Junling Wang
- Division of Health Science Administration, Department of Pharmaceutical Sciences, University of Tennessee College of Pharmacy, 847 Monroe Ave., Room 205R, Memphis, TN 38163, USA
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Wang J, Noel JM, Zuckerman IH, Miller NA, Shaya FT, Mullins CD. Disparities in access to essential new prescription drugs between non-Hispanic whites, non-Hispanic blacks, and Hispanic whites. Med Care Res Rev 2007; 63:742-63. [PMID: 17099124 DOI: 10.1177/1077558706293638] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prior studies do not address racial and ethnic disparities in essential new drug use and whether disparities decrease through time. Using the Medical Expenditure Panel Survey (1996-2001), racial and ethnic disparities were examined separately by comparing non-Hispanic whites to non-Hispanic blacks and Hispanic whites, respectively. New drugs were defined as approved within the past 5 years, and an expert panel identified essential drugs. Negative binomial models adjusted for socioeconomic and health characteristics. The mean annual number of times essential new drugs were obtained among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites were 1.02, 0.94, and 0.70, respectively. After adjusting for confounders, ethnic disparities generally were not significant, but racial disparities became significant. This study did not identify declining disparities during early years of drugs' life cycles. Disparities exist in new, essential drug acquisition between non-Hispanic whites and non-Hispanic blacks. Socioeconomic and health characteristics explain many of the observed disparities.
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Affiliation(s)
- Junling Wang
- University of Tennessee College of Pharmacy, USA
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Furner SE, Wallace K, Arguelles L, Miles T, Goldberg J. Twin study of depressive symptoms among older african-american women. J Gerontol B Psychol Sci Soc Sci 2007; 61:P355-61. [PMID: 17114305 DOI: 10.1093/geronb/61.6.p355] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This study examines factors associated with depressive symptoms in a genetically informative sample of African-American female twins aged 65 years and older. A telephone interview was conducted with 180 pairs of twins. Questions included demographics, health behaviors, health status, activities of daily living (ADLs), instrumental ADLs, and depressive symptoms as measured by the Center for Epidemiologic Studies-Depression scale. Regression methods for clustered data were used to examine the associations. In univariate analyses, ADLs (odds ratio or OR = 1.4, 95% confidence interval or CI = 1.1-1.7), fractures (OR = 4.4, 95% CI = 1.3-15.6), and vision problems (OR = 1.9, 95% CI = 1.0-3.8) were significantly associated with depressive symptoms. In multivariable analyses, ADLs (OR = 1.4, 95% CI = 1.2-1.7) and vision problems (OR = 2.0, 95% CI = 1.2-3.5) remained significantly associated with depressive symptoms. A within-pair analysis, controlling for genetic or familial influences, produced similar results. The results suggest that efforts targeted at reducing levels of disability may reduce depressive symptoms in this population.
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Affiliation(s)
- Sylvia E Furner
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, USA
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Lindblad CI, Hanlon JT, Gross CR, Sloane RJ, Pieper CF, Hajjar ER, Ruby CM, Schmader KE. Clinically important drug-disease interactions and their prevalence in older adults. Clin Ther 2006; 28:1133-1143. [PMID: 16982290 DOI: 10.1016/j.clinthera.2006.08.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Older adults may have decreased homeostatic reserve, have multiple chronic diseases, and take multiple medications. Therefore, they are at risk for adverse outcomes after receiving a drug that exacerbates a chronic disease. OBJECTIVES The aims of this study were to compile a list of clinically important drug-disease interactions in older adults, obtain the consensus of a multidisciplinary panel of geriatric health care professionals on these interactions, and determine the prevalence of these interactions in a sample of outpatients. METHODS This analysis included a 2-round modified Delphi survey and cross-sectional study. Possible drug-disease interactions in patients aged > or =65 years were identified through a search of the English-language literature indexed on MEDLINE and International Pharmaceutical Abstracts (1966-July 2004) using terms that included drug-disease interaction, medication errors, and inappropriate prescribing. Nine health care professionals with expertise in geriatrics (2 geriatricians, 7 geriatric clinical pharmacist specialists) were selected based on specialty training and continuing clinical work in geriatrics, academic appointments, and geographic location. The panel rated the importance of the potential drug-disease interactions using a 5-point Likert scale (from 1 = definitely not serious to 5 = definitely serious). Consensus on a drug-disease interaction was defined as a lower bound of the 95% CI > or =4.0. The prevalence of drug-disease interactions was determined by applying the consensus criteria to a convenience sample of frail older veterans at hospital discharge who were enrolled in a health services intervention trial. RESULTS The panel reached consensus on 28 individual drug-disease interactions involving 14 diseases or conditions. Overall, 205 (15.3%) of the 1340 veterans in the sample had > or =1 drug-disease interaction. The 2 most common drug-disease interactions were use of first-generation calcium channel blockers in patients with congestive heart failure and use of aspirin in patients with peptic ulcer disease (both, 3.7%). CONCLUSIONS A survey of multidisciplinary geriatric health care professionals resulted in a concise consensus list of clinically important drug-disease interactions in older adults. Further research is needed to examine the impact of these drug-disease interactions on health outcomes and their applicability as national measures for the prevention of drug-related problems.
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Affiliation(s)
- Catherine I Lindblad
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota; Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
| | - Joseph T Hanlon
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Center for Health Equity Research and Promotion, Geriatric Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh Pennsylvania, USA; Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh Pittsburgh, Pennsylvania, USA
| | - Cynthia R Gross
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Richard J Sloane
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Carl F Pieper
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA; Department of Biostatistics and Bioin formatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Emily R Hajjar
- Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christine M Ruby
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh Pittsburgh, Pennsylvania, USA
| | - Kenneth E Schmader
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA; Division of Geriatric Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina, USA
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Sleath BL, Jackson E, Thomas KC, Galloway J, Dumain L, Thorpe J, Rollins A, Morrissey J. Literacy and perceived barriers to medication taking among homeless mothers and their children. Am J Health Syst Pharm 2006; 63:346-51. [PMID: 16452520 DOI: 10.2146/ajhp050070] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The relation of medical literacy to women-reported barriers to taking medication themselves or giving medication to their children was studied. METHODS Women in 18 homeless shelters in four counties in central North Carolina were recruited. Head-of-household homeless mothers with psychiatric or substance-abuse disorders and dependent children were eligible to participate. Trained interviewers administered a site-specific questionnaire on medication use. RESULTS One hundred sixty-four homeless women participated. Forty-two percent of the women were currently taking a medication. Forty-six percent of the women stated that there was a barrier to taking their medications as prescribed. Medical literacy was not significantly related to whether women felt there were barriers to taking a medication. Seventy-five percent of the women reported having one or more children living with them. Thirty-seven percent reported having a child with asthma live with them, and 12% reported having a child with attention-deficit disorder. Forty percent reported a barrier to giving their child a needed medication. Taste was the most commonly reported barrier. Women with lower medical literacy and younger women were significantly more likely to report a barrier to giving their children a needed medication. Over 80% of women listed pharmacists as their first or second choice for receiving drug information orally. CONCLUSION Race and perceived barriers to medication use affected the medication-taking behavior of homeless women, while their age and literacy level affected the reporting rates of the barriers to medication use for their children. Homeless women preferred receiving both written and oral drug information from a physician or a pharmacist.
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Affiliation(s)
- Betsy L Sleath
- Cecil G. Sheps Center for Health Services Research, School of Pharmacy, University of North Carolina at Chapel Hill (UNCCH), 27599-7590, USA.
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Fillenbaum GG, Hybels CF, Pieper CF, Konrad TR, Burchett BM, Blazer DG. Provider Characteristics Related to Antidepressant Use in Older People. J Am Geriatr Soc 2006; 54:942-9. [PMID: 16776790 DOI: 10.1111/j.1532-5415.2006.00737.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether the characteristics of the usual medical care providers of older antidepressant users changed between 1986 and 1997 with the introduction of selective serotonin reuptake inhibitors. DESIGN Longitudinal study. SETTING Five-county Piedmont area of North Carolina. PARTICIPANTS Stratified random sample of African-American (n=2,261) and white (n=1,875) community residents aged 65 to 105. MEASUREMENTS Sample members provided information on prescription medications, demographic and health status, and usual medical care provider (matched to North Carolina Health Professions Data Systems files to ascertain provider characteristics) in 1986/87, 1989/90, 1992/93, and 1996/97. Most (77.5%) named a provider (name unmatchable for 4.1%). Sample member characteristics were aggregated into probability (propensity) scores summarizing predisposing (demographic), enabling (medical care access), and need (health status) categories. Along with wave of study and whether a provider was named, these were entered as control variables in generalized estimating equation models that examined the association between provider race (white vs nonwhite), sex, age, location of practice, and primary versus specialist care and antidepressant use. RESULTS The characteristics of the usual medical care providers remained stable over the decade, although prevalence of antidepressant use increased. Two provider characteristics--race and area of practice (but not the interaction between them)--were significantly associated with patients' use of antidepressants. Patients of white physicians and of physicians with urban practices were more likely to use antidepressants. CONCLUSION Although use of antidepressants has increased over time, there has been little change in the characteristics of users' usual medical care providers.
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Affiliation(s)
- Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA.
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Gray SL, Odegard PS, Sales AEB, Young HM, Sullivan JH, Hedrick SC. Quality of Medication Records and Use of Pharmacy Resources in Community Residential Care Facilities. Ann Pharmacother 2006; 40:894-9. [PMID: 16638918 DOI: 10.1345/aph.1g585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: In community residential care (CRC) facilities, medication administration is often performed by unlicensed personnel with minimal knowledge in medication use. Medication management is one of the top 3 quality-of-care issues facing these facilities. Objective: To examine the type of medication assistance residents received, determine the proportion of facilities that used pharmacy resources, and examine the quality of facility medication records in CRC facilities (eg, adult family homes, adult residential care, assisted living facilities). Methods: Baseline in-person interviews were conducted with 349 residents and 299 facility providers in the Puget Sound region of Washington. Information was also obtained from facility medication records at enrollment and state databases. A pharmacist determined quality of the records using a standardized form. Results: The average resident was a 78-year-old white female taking 7 drugs. Medication records that were computer generated were significantly less likely to have misspelled names of drugs and errors in or absence of dose, directions for use, and route of administration. Overall, 26.3% of facilities reported that a consultant pharmacist reviewed residents' medication lists, 52.0% reported the use of preprinted lists, and 75.6% received prepackaged medications from the pharmacy. Adult family homes, the smallest facility type, were the least likely to use pharmacy-related services. Conclusions: The quality of handwritten medication records was a concern in CRC facilities. These facilities may benefit from services offered by pharmacies that may enhance medication management, many of which were underutilized.
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Affiliation(s)
- Shelly L Gray
- Geriatric Pharmacy Program, School of Pharmacy, University of Washington, Seattle, WA 98195-7630, USA.
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Gray SL, LaCroix AZ, Hanlon JT, Penninx BWJH, Blough DK, Leveille SG, Artz MB, Guralnik JM, Buchner DM. Benzodiazepine use and physical disability in community-dwelling older adults. J Am Geriatr Soc 2006; 54:224-30. [PMID: 16460372 PMCID: PMC2365497 DOI: 10.1111/j.1532-5415.2005.00571.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether benzodiazepine use is associated with incident disability in mobility and activities of daily living (ADLs) in older individuals. DESIGN A prospective cohort study. SETTING Four sites of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS This study included 9,093 subjects (aged > or =65) who were not disabled in mobility or ADLs at baseline. MEASUREMENTS Mobility disability was defined as inability to walk half a mile or climb one flight of stairs. ADL disability was defined as inability to perform one or more basic ADLs (bathing, eating, dressing, transferring from a bed to a chair, using the toilet, or walking across a small room). Trained interviewers assessed outcomes annually. RESULTS At baseline, 5.5% of subjects reported benzodiazepine use. In multivariable models, benzodiazepine users were 1.23 times as likely as nonusers (95% confidence interval (CI) = 1.09-1.39) to develop mobility disability and 1.28 times as likely (95% CI = 1.09-1.52) to develop ADL disability. Risk for incident mobility was increased with short- (hazard ratio (HR) = 1.27, 95% CI = 1.08-1.50) and long-acting benzodiazepines (HR = 1.20, 95% CI = 1.03-1.39) and no use. Risk for ADL disability was greater with short- (HR = 1.58, 95% CI = 1.25-2.01) but not long-acting (HR = 1.11, 95% CI = 0.89-1.39) agents than for no use. CONCLUSION Older adults taking benzodiazepines have a greater risk for incident mobility and ADL disability. Use of short-acting agents does not appear to confer any safety benefits over long-acting agents.
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Affiliation(s)
- Shelly L Gray
- School of Pharmacy, University of Washington, Seattle, Washington 98195, USA.
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Artz MB, Harnack LJ, Duval SJ, Armstrong C, Arnett DK, Luepker RV. Use of nonprescription medications for perceived cardiovascular health. Am J Prev Med 2006; 30:78-81. [PMID: 16414428 DOI: 10.1016/j.amepre.2005.08.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Revised: 07/29/2005] [Accepted: 08/26/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nonprescription products (over-the-counter drugs; vitamins/minerals; and nonvitamin, nonmineral supplements) are promoted or advertised for cardiovascular health. The extent of nonprescription products used specifically for perceived cardiovascular health (NONRX-CVH) is unknown. This study aimed to (1) determine prevalence and types of nonprescription medications used for NONRX-CVH, (2) compare the demographics of NONRX-CVH users to persons using nonprescription medications in general, and (3) determine the prevalence of use of NONRX-CVH among those taking a prescription medication for a cardiovascular reason. METHODS A cross-sectional survey comprised the probability sample of 3128 adults in the Minneapolis-St. Paul area in the 2000-2002 Minnesota Heart Survey. Trained interviewers collected medication information from participants using a structured medication inventory approach. RESULTS Analysis in 2005 shows that 10% of participants (n=315) self-reported taking one or more nonprescription medications in the past 2 weeks for a perceived cardiovascular health purpose. Among these individuals, prevalence of use of vitamin/mineral supplements, nonvitamin/nonmineral supplements, and over-the-counter products for a cardiovascular purpose was 37.5%, 21.3%, and 54.6%, respectively. Popular NONRX-CVHs were aspirin (52.1%), vitamin E (24.4%), garlic (9.8%), and omega-3/fish oils/fatty acids (3.8%). NONRX-CVH users were older than general nonprescription users (p<0.001). Of 613 people using a prescription drug for cardiovascular reasons, 135 (22%) reported using one or more NONRX-CVH medications. CONCLUSIONS Use of NONRX-CVHs, especially aspirin, vitamin E, and herbals, is common, and older patients may use aspirin or dietary supplements for this purpose. Physicians having patients with cardiovascular disease should ask about nonprescription medication usage, as some NONRX-CVHs may be inappropriate.
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Affiliation(s)
- Margaret B Artz
- Department of Pharmaceutical Health Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Suh DC, Thomas SK, Valiyeva E, Arcona S, Vo L. Drug persistency of two cholinesterase inhibitors: rivastigmine versus donepezil in elderly patients with Alzheimer's disease. Drugs Aging 2005; 22:695-707. [PMID: 16060719 DOI: 10.2165/00002512-200522080-00006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare persistency rates and persistency days in patients with Alzheimer's disease (AD) who initiated therapy with either rivastigmine or donepezil, and to identify factors influencing persistency in a real-world setting. DESIGN AND METHODS This study used data collected by MarketScan from 1 January 1999 to 31 December 2002. Patients were included if they were newly diagnosed with AD and filled at least one prescription for rivastigmine or donepezil between 1 July 2000 and 30 June 2001, were > or =65 years of age on the index prescription date, and had continuous health and prescription insurance during the entire study period. Patients were excluded if they filled a prescription for any cholinesterase inhibitor during the 18 months prior to initiation of the study drugs. Patients who refilled their initial cholinesterase inhibitor prescription within a permissible gap of 60 days after depleting the drug supply from the prior prescription were considered to be persistent. Sensitivity analysis was performed to test the robustness of the persistency definition. The Kaplan-Meier method was used to determine persistency rates across time and Cox proportional hazards models were used to estimate relative risks of discontinuation or switch with adjustment for other covariates, and to identify factors significantly influencing persistency of the study drugs. RESULTS Of the newly treated AD patients, the proportion of rivastigmine and donepezil patients who continued their medication was the same (47%; p = 0.5). On average, rivastigmine users continuously used their medication for 234 days (median 312 days) while those taking donepezil used their medication for 235 days (median 315 days) [p = 0.91]. Patients were more likely to discontinue or switch their initial cholinesterase inhibitor if they used a central nervous system (CNS) medication before initiation of therapy (relative risk [RR] = 1.23; 95% CI 1.01, 1.51 without adjustment for study variables; RR = 1.30; 95% CI 1.05, 1.60 with adjustment for study variables). On the other hand, patients were less likely to discontinue their cholinesterase inhibitor if they visited their physician office frequently (RR = 0.24; 95% CI 0.18, 0.32 without adjustment; RR = 0.23; 95% CI 0.17, 0.30 with adjustment) or if they were hospitalised after initiation of their cholinesterase inhibitor therapy (RR = 0.60; 95% CI 0.39, 0.91 without adjustment; RR = 0.65; 95% CI 0.42, 0.99 with adjustment). CONCLUSION Patients who were newly diagnosed with AD and initiated therapy with either rivastigmine or donepezil had similar levels of persistency with their initial AD therapy in a real-world setting.
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Affiliation(s)
- Dong-Churl Suh
- Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey 08854, USA.
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Hajjar ER, Hanlon JT, Sloane RJ, Lindblad CI, Pieper CF, Ruby CM, Branch LC, Schmader KE. Unnecessary drug use in frail older people at hospital discharge. J Am Geriatr Soc 2005; 53:1518-23. [PMID: 16137281 DOI: 10.1111/j.1532-5415.2005.53523.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To determine the prevalence and predictors of unnecessary drug use at hospital discharge in frail elderly patients. DESIGN Cross-sectional. SETTING Eleven Veterans Affairs Medical Centers. PARTICIPANTS Three hundred eighty-four frail older patients from the Geriatric Evaluation and Management Drug Study. MEASUREMENTS Assessment of unnecessary drug use was determined by the consensus of a clinical pharmacist and physician pair applying the Medication Appropriateness Index to each regularly scheduled medication at hospital discharge. Those drugs that received an inappropriate rating for indication, efficacy, or therapeutic duplication were defined as unnecessary. RESULTS Forty-four percent of patients had at least one unnecessary drug, with the most common reason being lack of indication. The most commonly prescribed unnecessary drug classes were gastrointestinal, central nervous system, and therapeutic nutrients/minerals. Factors associated (P<.05) with unnecessary drug use included hypertension (adjusted odds ratio (AOR)=0.61, 95% confidence interval (CI)=0.38-0.96), multiple prescribers (AOR=3.35, 95% CI=1.16-9.68), and nine or more medications (AOR=2.24, 95% CI=1.25-3.99). CONCLUSION A high prevalence of unnecessary drug use at discharge was found in frail hospitalized elderly patients. Additional studies are needed to identify predictors and prevalence of unnecessary drug use in nonveteran populations so that interventions can be designed to reduce the problem.
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Affiliation(s)
- Emily R Hajjar
- Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Pennsylvania 19104, USA.
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Fillenbaum GG, Kuchibhatla MN, Hanlon JT, Artz MB, Pieper CF, Schmader KE, Dysken MW, Gray SL. Dementia and Alzheimer's disease in community-dwelling elders taking vitamin C and/or vitamin E. Ann Pharmacother 2005; 39:2009-14. [PMID: 16227448 DOI: 10.1345/aph.1g280] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Since increased oxidative stress may impair cognition and be a risk factor for dementia, there has been interest in determining whether use of antioxidants could protect against such events. OBJECTIVE To determine whether supplement use of vitamins C and/or E in a community-based sample of older African American and white individuals delayed incident dementia or Alzheimer's disease (AD). METHODS We selected a subgroup from the Duke Established Populations for Epidemiologic Studies of the Elderly, a longitudinal study of community-representative persons aged 65-105 years living in 5 adjacent counties in North Carolina, and followed them for dementia (1986-1987 through June 2000). Information gathered during in-home interviews included sociodemographic characteristics, health status, health service use, and vitamin use. Diagnosis of dementia and AD was based on evaluations using the clinical and neuropsychological batteries of the Consortium to Establish a Registry for Alzheimer's Disease, with final determination by consensus agreement of specialists using Diagnostic and Statistical Manual of Mental Disorders, third revision, and National Institute for Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders criteria. RESULTS Of 616 persons initially dementia-free (mean age 73 y; 62% female; 62% African American), 141 developed dementia, of whom 93 developed AD. Increased age and mobility problems were risk factors for dementia (only age for AD), while an increased number of outpatient visits reduced the likelihood of developing dementia. Neither use of any vitamins C and/or E (used by 8% of subjects at baseline) nor high-dose use reduced the time to dementia or AD. CONCLUSIONS In this community in the southeastern US where vitamin supplement use is low, use of vitamins C and/or E did not delay the incidence of dementia or AD.
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Affiliation(s)
- Gerda G Fillenbaum
- Duke University Medical Center and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, NC 27710, USA.
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Wang PS, Schneeweiss S, Brookhart MA, Glynn RJ, Mogun H, Patrick AR, Avorn J. Suboptimal antidepressant use in the elderly. J Clin Psychopharmacol 2005; 25:118-26. [PMID: 15738742 DOI: 10.1097/01.jcp.0000155819.67209.e5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ongoing changes in available agents and health care delivery systems have made it imperative to study the quality of antidepressant use in vulnerable and traditionally underserved elderly. We conducted a retrospective cohort study among 12,130 new antidepressant users aged > or =65 years with a recent diagnosis of depression in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly Program from January 1, 1994, to December 31, 1999. Additional use information was available through Medicare data. Potentially hazardous antidepressant regimens were defined as use of highly anticholinergic agents or daily dosages in excess of geriatric prescribing guidelines. Low-intensity regimens were defined by lower than recommended daily dosages, too-short durations of therapy, or lack of follow-up. Of all elderly antidepressant users, 43.3% were taking suboptimal regimens. Potentially hazardous regimens were used by 11.9%, including 7.3% taking highly anticholinergic agents and 5.3% using excessively high daily dosages. Low-intensity regimens were used by 34.8% of patients, including 7.6% with excessively low daily dosages, 19.3% with short durations of therapy, and 14.8% with inadequate follow-up. Potentially hazardous regimens were associated with ages 65 to 74 years, nursing home residence, cancer diagnoses, less comorbidity, use of other psychiatric medications, making more physician visits, and earlier calendar years. Low-intensity regimens were associated with ages > or =85 years, nonwhite race, greater comorbidity, fewer physician visits or inpatient days in the baseline 6 months, and not using other psychiatric medications. Suboptimal antidepressant use remains common in the elderly, especially the use of inadequately intensive regimens. Interventions are needed to improve the quality and outcomes of antidepressant use in this vulnerable population.
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Affiliation(s)
- Philip S Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
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Hanlon JT, Landerman LR, Artz MB, Gray SL, Fillenbaum GG, Schmader KE. Histamine2 receptor antagonist use and decline in cognitive function among community dwelling elderly. Pharmacoepidemiol Drug Saf 2005; 13:781-7. [PMID: 15386717 DOI: 10.1002/pds.952] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Previous studies have reported mixed results regarding the use of histamine(2) receptor antagonist use and cognitive function. This study evaluated the relationship between the use of histamine(2) receptor antagonists and cognitive decline among community dwelling elderly. METHODS This cohort study included 2082 subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly who were not cognitively impaired at baseline (1989/90). Histamine(2) receptor antagonist use was determined during in-home interviews. Cognitive function was assessed at 3 and 7 years after baseline by two measures: (1) incident cognitive impairment defined by the short portable mental status questionnaire (SPMSQ); and (2) cognitive decline (increase in two or more SPMSQ errors). Analyzes used multivariable discrete-time hazard models with weighted data adjusted for sampling design and controlled for demographic, health behavior characteristics and health status. RESULTS At baseline, nearly 5% of participants used a histamine(2) receptor antagonist. During follow-up, incident cognitive impairment occurred in 24.0%, whereas 34.5% increased by two or more errors on the SPMSQ. In multivariable models, current histamine(2) receptor antagonist users compared to never users had a higher risk for cognitive impairment (Adj. RR 1.51; 95%CI 0.93-2.47) and for decline in performance (increase of two or more errors) on the SPMSQ (Adj. RR 1.24; 95%CI 0.74-2.08). A nonsignificant increased risk of cognitive impairment and decline with either higher dose or short-term use was found whereas a nonsignificant protective effect on cognitive decline with current long-term use was seen. CONCLUSIONS These results suggest no beneficial effects, and perhaps a detrimental effect, of histamine(2) receptor antagonist use on cognitive function in community dwelling elderly.
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Affiliation(s)
- Joseph T Hanlon
- Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, 7-115 Weaver-Densford Hall, University of Minnesota, 308 Harvard Street., Minneapolis, MN 55455, USA.
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Sharkey JR, Browne B, Ory MG, Wang S. Patterns of therapeutic prescription medication category use among community-dwelling homebound older adults. Pharmacoepidemiol Drug Saf 2005; 14:715-23. [PMID: 15651081 DOI: 10.1002/pds.1066] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE The measurement of prescription medication use is usually through a simple count of medications, which tends to ignore therapeutic categories. This research investigated prescription medication use among homebound older adults, by documenting the therapeutic prescription medication categories used by these individuals and identifying the factors associated with use of multiple therapeutic categories. METHODS Baseline Nutrition and Function Study (2000-2001) data from 326 homebound older persons who completed the medication review component (visual inspection of medications) of the baseline in-home interview and used > or =1 prescribed medication were included in this analysis. RESULTS More than 40% (n = 133) regularly took medications from three to four different therapeutic categories and 31.6% (n = 103) used > or =5 different therapeutic categories. The use of respiratory medications declined with increasing age, and more women than men used diuretic and thyroid replacement medications. Independent of other factors, increased use of multiple therapeutic categories was associated with sociodemographic characteristics (gender, age, living arrangement, marital status and medication coverage), medical conditions (diabetes, heart problems and lung disease) and inability to self-manage medications. CONCLUSIONS Our findings suggest that individual characteristics and medical conditions may help identify homebound elders at high risk for using prescription medications from an increased number of different therapeutic categories. This observation may help clinicians and community-based providers of services to older persons to be aware of differences in therapeutic medication use within an older population, and how patterns of use may alter service needs.
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Affiliation(s)
- Joseph R Sharkey
- Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M University System Health Sciences Center, College Station, TX 77840, USA.
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Fillenbaum GG, Hanlon JT, Landerman LR, Artz MB, O'Connor H, Dowd B, Gross CR, Boult C, Garrard J, Schmader KE. Impact of inappropriate drug use on health services utilization among representative older community-dwelling residents. ACTA ACUST UNITED AC 2004; 2:92-101. [PMID: 15555485 DOI: 10.1016/s1543-5946(04)90014-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is limited objective information regarding the impact of drugs identified as inappropriate by drug utilization review (DUR) or the Beers drugs-to-avoid criteria on health service use. OBJECTIVE The goal of this study was to examine the predictive validity of DUR and the Beers criteria employed to define inappropriate drug use in representative community residents, aged >or=68 years, as determined by the relationship of these criteria to health service use in older community residents. METHODS Data came from participants in the Duke University Established Populations for Epidemiologic Studies of the Elderly seen in 1989/1990 and for whom information was also available 3 years later. Two sets of inappropriate drug use criteria were examined: (1) DUR regarding dosage, duration, duplication, and drug-drug and drug-disease interactions; and (2) the Beers criteria, applied to drug use reported in an in-home interview. Outpatient visits and nursing-home entry were determined by personal report; hospitalization information came from Medicare Part A files from the Centers for Medicare and Medicaid Services. RESULTS A total of 3165 participants were available at the fourth interview in 1989/1990. The majority were aged >74 years (51.1%), white (64.8%), women (64.7%), had fair or poor health (77.0%), consistently saw the same physician (86.9%), and possessed supplemental health insurance (62.8%). Use of inappropriate drugs meeting DUR criteria, especially for drug-drug or drug-disease interaction problems, was associated with increased outpatient visits (P<0.05) but not with time to hospitalization or time to nursing home entry. The use of inappropriate drugs according to the Beers criteria was associated with reduced time to hospitalization (adjusted hazard ratio, 1.20; 95% CI, 1.04-1.39) but not to outpatient visits or nursing home entry. CONCLUSIONS Our data suggest that in representative community residents aged >or=68 years, current criteria for inappropriate drug use should be used with caution in evaluating quality of care because they have minimal impact on use of health services. We found increases only in the use of outpatient services (with DUR) and more rapid use of hospitalization (with the Beers criteria).
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Affiliation(s)
- Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA.
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Gray SL, Hanlon JT, Landerman LR, Artz M, Schmader KE, Fillenbaum GG. Is antioxidant use protective of cognitive function in the community-dwelling elderly? ACTA ACUST UNITED AC 2004; 1:3-10. [PMID: 15555461 DOI: 10.1016/s1543-5946(03)80011-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2003] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of oxidative stress in the pathogenesis of diseases such as macular degeneration, certain types of cancer, and Alzheimer's disease has received much attention. Thus, there is considerable interest in the potential contribution of antioxidants to the prevention of these diseases. OBJECTIVE The objective of this study was to determine whether use of supplemental antioxidants (vitamins A, C, or E, plus selenium or zinc) was associated with a reduced risk of development of cognitive impairment or cognitive decline in a representative sample of the community-dwelling elderly. METHODS The sample consisted of 2082 nonproxy subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly who were not cognitively impaired at the 1989-1990 interview (baseline for the present analysis). Medication use was determined during in-home interviews. Cognitive function was assessed 3 and 7 years from baseline in terms of incident cognitive impairment, as measured on the Short Portable Mental Status Questionnaire (SPMSQ) using specific cut points (number of errors) based on race and education, and cognitive decline, defined as an increase of > or = 2 errors on the SPMSQ. Multivariate analyses were performed using weighted data adjusted for sampling design and controlled for sociodemographic characteristics, health-related behaviors, and health status. RESULTS At baseline, 224 (10.8%) subjects were currently taking a supplement containing an antioxidant. During the follow-up period, 24.0% of subjects developed cognitive impairment and 34.5% experienced cognitive decline. Current antioxidant users had a 34.0% lower risk of developing cognitive impairment compared with non-antioxidant users (adjusted relative risk [RR], 0.66; 95% CI, 0.44-1.00) and a 29.0% lower risk of experiencing cognitive decline (adjusted RR, 0.71; 95% CI, 0.49-1.01). CONCLUSION The results of this analysis suggest a possible beneficial effect of antioxidant use in terms of reducing cognitive decline among the community-dwelling elderly.
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Affiliation(s)
- Shelly L Gray
- School of Pharmacy, University of Washington, Seattle, Washington 98195, USA.
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Sleath B, Thorpe J, Landerman LR, Doyle M, Clipp E. Medication use among black and white caregivers of older male veterans with dementia. ACTA ACUST UNITED AC 2004; 2:133-40. [PMID: 15555489 DOI: 10.1016/s1543-5946(04)90018-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have examined racial differences in medication use among informal caregivers of elderly individuals with progressive dementia. It is important to identify racial disparities in medication use so that these differences can be corrected. OBJECTIVE The purpose of the current study was (1) to evaluate whether black caregivers were less likely to be taking medication than white caregivers after controlling for specific factors and (2) to examine the relationship between caregiver race and other predisposing, enabling, and need factors, and the use of specific categories of medications. METHODS A secondary analysis of data was conducted from a national survey of 2032 black and white female caregivers of elderly male US veterans with a diagnosis of Alzheimer's disease or vascular dementia. Caregiver use of specific medications was classified according to the Veterans Affairs medication classification system. The Andersen Behavioral Model of Health Services Use provided a framework for multivariate models predicting racial differences in any medication use and use of specific categories of medications. RESULTS Black caregivers were significantly less likely to use any medication than white caregivers (adjusted odds ratio [OR]=0.42; 95% CI=0.31-0.57). These differences persisted even after controlling for other predisposing, enabling, and need factors, and for outpatient doctor visits. Black caregivers were significantly less likely than white caregivers to be taking endocrine/metabolic medications (adjusted OR=0.57; 95% CI=0.42-0.77) and central nervous system medications (adjusted OR=0.57; 95% CI=0.39-0.83). CONCLUSION The results of this analysis suggest that significant racial differences in medication use exist among informal caregivers providing care for elderly male US veterans with progressive dementia.
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Affiliation(s)
- Betsy Sleath
- University of North Carolina School of Pharmacy, Chapel Hill, NC 27599-3386, USA.
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O’Neil CK. Introduction. J Pharm Pract 2004. [DOI: 10.1177/0897190004263979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Christine K. O’Neil
- Division of Social, Clinical, and Administrative Science, Mylan School of Pharmacy, Duquesne University Pittsburgh, Pennsylvania,
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Schmader KE, Hanlon JT, Pieper CF, Sloane R, Ruby CM, Twersky J, Francis SD, Branch LG, Lindblad CI, Artz M, Weinberger M, Feussner JR, Cohen HJ. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med 2004; 116:394-401. [PMID: 15006588 DOI: 10.1016/j.amjmed.2003.10.031] [Citation(s) in RCA: 231] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2003] [Revised: 10/02/2003] [Accepted: 10/20/2003] [Indexed: 01/19/2023]
Abstract
PURPOSE To determine if inpatient or outpatient geriatric evaluation and management, as compared with usual care, reduces adverse drug reactions and suboptimal prescribing in frail elderly patients. METHODS The study employed a randomized 2 x 2 factorial controlled design. Subjects were patients in 11 Veterans Affairs (VA) hospitals who were > or =65 years old and met criteria for frailty (n = 834). Inpatient geriatric unit and outpatient geriatric clinic teams evaluated and managed patients according to published guidelines and VA standards. Patients were followed for 12 months. Blinded physician-pharmacist pairs rated adverse drug reactions for causality (using Naranjo's algorithm) and seriousness. Suboptimal prescribing measures included unnecessary and inappropriate drug use (Medication Appropriateness Index), inappropriate drug use (Beers criteria), and underuse. RESULTS For serious adverse drug reactions, there were no inpatient geriatric unit effects during the inpatient or outpatient follow-up periods. Outpatient geriatric clinic care resulted in a 35% reduction in the risk of a serious adverse drug reaction compared with usual care (adjusted relative risk = 0.65; 95% confidence interval: 0.45 to 0.93). Inpatient geriatric unit care reduced unnecessary and inappropriate drug use and underuse significantly during the inpatient period (P <0.05). Outpatient geriatric clinic care reduced the number of conditions with omitted drugs significantly during the outpatient period (P <0.05). CONCLUSION Compared with usual care, outpatient geriatric evaluation and management reduces serious adverse drug reactions, and inpatient and outpatient geriatric evaluation and management reduces suboptimal prescribing, in frail elderly patients.
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Glover DD, Rybeck BF, Tracy TS. Medication use in a rural gynecologic population: prescription, over-the-counter, and herbal medicines. Am J Obstet Gynecol 2004; 190:351-7. [PMID: 14981373 DOI: 10.1016/j.ajog.2003.08.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to document current medication use by a rural female population. STUDY DESIGN Over a 42-month period, nonpregnant women were interviewed about medication use. When applicable, interviews on subsequent visits provided a longitudinal study of medication usage and discontinuation, and data were analyzed according to the number of drugs used, age, and payment status. RESULTS Five hundred sixty-seven participants had 776 interviews. Ninety-two percent of the participants took prescription medications, 96.5% of the participants self-medicated with over-the-counter medications, and 59.1% of the participants used herbal medications. Usage of prescription medications increased with age and, in some instances, varied with payment status. A database query for potential interacting drugs found several instances of coadministration, including herbal medicines that were not prescribed by the physician. CONCLUSION Medication usage (all types) by rural women is substantial, and the frequency of usage varies on the basis of both age and payment status. Patients should also be queried concerning medications that are not prescribed by the physician for an assessment of potential drug interactions.
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Affiliation(s)
- Douglas D Glover
- Department of Obstetrics and Gynecology, School of Medicine, Consortium on Reproductive and Developmental Health, Robert C. Byrd Health Sciences Center of West Virginia University, Morgantown, WV, USA
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